Supraventricular Tachycardia: Difference between revisions

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==Section 4 - CARDIAC 4.07==
==Section 4 - CARDIAC 4.07==
===SUPRAVENTRICULAR TACHYCARDIA (Heart Rate > 160 beats / minute)===
====CONSIDER MEDICAL ETIOLOGY OF SVT AND REFER TO APPROPRIATE PRACTICE PARAMETER:====
 
* Heart failure, [[Acute Cardiogenic Pulmonary Edema Pneumonia|PULMONARY EDEMA (4.11)]].
CONSIDER MEDICAL ETIOLOGY OF SVT AND REFER TO APPROPRIATE PRACTICE PARAMETER:
* Hypovolemia, [[Shock|SHOCK (5.13)]].
* Heart failure, [[Acute Cardiogenic Pulmonary Edema Pneumonia|PULMONARY EDEMA]] (4.11).
* Hypovolemia, [[Shock|SHOCK]] (5.13).
* Side-effects of other drugs, etc.
* Side-effects of other drugs, etc.


[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE (2.01)]] - OXYGEN @ 100% via NRB mask.


'''[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01) - [[Medical Gases|OXYGEN]] @ 100% via NRB mask.'''
====STABLE NARROW COMPLEX TACHYCARDIA:====
 
* Initiate large bore IV, preferably at antecubital fossae
 
* Administer [[Antiarrhythmics|ADENOSINE]] 6 mg RAPID IVP, administered at a port closest to the IV site, followed immediately by a rapid 10-20 ml saline flush
'''''STABLE and SYMPTOMATIC:'''''
* If NO response in 2 minutes, [[Antiarrhythmics|ADENOSINE]] 12 mg RAPID IVP followed immediately by a rapid 10-20 ml saline flush (Maximum dose 18 mg)
 
* Initiate large bore IV, preferably at AC.
* [[Antiarrhythmics|ADENOSINE]] 6 mg RAPID IVP, administered at a port closest to the IV site, followed immediately by a rapid 10 ml saline flush.
* If NO response in 2 minutes, [[Antiarrhythmics|ADENOSINE]]12 mg RAPID IVP followed immediately by a rapid 10 ml saline flush. May repeat once in 2 minutes. (Maximum total dose 30 mg)
 
 
'''''UNSTABLE:'''''
* If IV established prior to patient becoming UNSTABLE, may administer [[Antiarrhythmics|ADENOSINE]]6 mg RAPID IVP. If unrelieved, consider sedation with [[Sedative Hypnotics|VERSED]] (2.04) if patient is conscious and proceed with below therapies.
* [[Cardioversion|SYNCHRONIZED CARDIOVERSION]] @ 50 Joules. May repeat [[Sedative Hypnotics|VERSED]], if necessary.
* If NO response, [[Cardioversion|SYNCHRONIZED CARDIOVERSION]] @ 100 Joules.
* If NO response, [[Cardioversion|SYNCHRONIZED CARDIOVERSION]] @ 200 Joules.
* If NO response, [[Cardioversion|SYNCHRONIZED CARDIOVERSION]] @ 300 Joules.


====UNSTABLE:====
{| class="wikitable"
|-
! Definition of Unstable: Persistent Narrow Complex Tachyarrhythmia causing:
|-
|
*Hypotension or signs of decreased tissue perfusion
*Significant dyspnea or significant compromise of the airway
*Acute mental status change
*Signs/symptoms of shock
*Acute heart failure
*Ischemic chest discomfort
|}


'''''Physician's Orders: If NO response, contact Medical Control for consult.'''''


This Standing Order is divided between the care and treatment of the stable patient verses the unstable patient. As a matter of definition agreed upon by the Medical Directors, the UNSTABLE patient is one who presents with any of the following: '''''SIGNIFICANT CARDIAC, SUSPECTED CARDIAC, SIGNIFICANT DYSPNEA, ALTERED MENTAL STATUS, OR HYPOTENSION WITH SIGNS OF DECREASED TISSUE PERFUSION, OR SIGNIFICANT COMPROMISE OF AIRWAY, BREATHING, AND/OR CIRCULATION.'''''  
* If IV established prior to patient becoming UNSTABLE, may administer [[Antiarrhythmics|ADENOSINE]]6 mg RAPID IVP. If unrelieved, consider sedation with [[Analgesia and Sedation|VERSED (2.04)]] if patient is conscious and proceed with below therapies.
** '''SYNCHRONIZED CARDIOVERSION'''
*** Initial recommended doses:
**** If narrow and regular complexes 50-100 Joules biphasic
**** If narrow and irregular complexes 120-200 Joules biphasic
**** If wide and regular complexes 100 Joules biphasic
**** If wide and irregular complexes – use defibrillation dose (not synchronized)


'''If the patient presents with one or more of the above UNSTABLE criteria, [[Defibrillation|DEFIBRILLATION]] should be administered to avoid delays associated with synchronization.'''
'''''Physician's Orders: If NO response, contact Medical Control for consult.'''''

Revision as of 14:37, 3 May 2012

Section 4 - CARDIAC 4.07

CONSIDER MEDICAL ETIOLOGY OF SVT AND REFER TO APPROPRIATE PRACTICE PARAMETER:

INITIAL MEDICAL CARE (2.01) - OXYGEN @ 100% via NRB mask.

STABLE NARROW COMPLEX TACHYCARDIA:

  • Initiate large bore IV, preferably at antecubital fossae
  • Administer ADENOSINE 6 mg RAPID IVP, administered at a port closest to the IV site, followed immediately by a rapid 10-20 ml saline flush
  • If NO response in 2 minutes, ADENOSINE 12 mg RAPID IVP followed immediately by a rapid 10-20 ml saline flush (Maximum dose 18 mg)

UNSTABLE:

Definition of Unstable: Persistent Narrow Complex Tachyarrhythmia causing:
  • Hypotension or signs of decreased tissue perfusion
  • Significant dyspnea or significant compromise of the airway
  • Acute mental status change
  • Signs/symptoms of shock
  • Acute heart failure
  • Ischemic chest discomfort


  • If IV established prior to patient becoming UNSTABLE, may administer ADENOSINE6 mg RAPID IVP. If unrelieved, consider sedation with VERSED (2.04) if patient is conscious and proceed with below therapies.
    • SYNCHRONIZED CARDIOVERSION
      • Initial recommended doses:
        • If narrow and regular complexes 50-100 Joules biphasic
        • If narrow and irregular complexes 120-200 Joules biphasic
        • If wide and regular complexes 100 Joules biphasic
        • If wide and irregular complexes – use defibrillation dose (not synchronized)

Physician's Orders: If NO response, contact Medical Control for consult.

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